We are currently translating the website, please come back later.
We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.

Margherita PIZZICANNELLA

MD
IRCAD-IHU
Strasbourg, France
12 videos
13.7K views
16 comments
105 likes
Share this profile on
Filter by
Specialties Clear filter
View more
Media type Clear filter
View more
Publication date
Sort by:
Endoscopic sleeve gastroplasty (ESG): live educational procedure with resolution of device-related complication
Endoscopic sleeve gastroplasty (ESG) is a novel endobariatric procedure with a mechanism of action totally different from the one used for a standard sleeve gastrectomy. An over-the-scope suturing system (OverStitch™, Apollo Endosurgery, Austin, TX) mounted on a dual-channel gastroscope (GIF- 2TH180, Olympus, Center Valley, PA) allowed to place full-thickness sutures in order to obtain gastric volume reduction and shrinking. The number of applied sutures relies on the gastric volume. Sutures are placed starting from the incisura to the fundus that is spared in a U-shaped fashion. A tissue-retracting helix device is used to grab the gastric wall. In this live educational video, Professor Silvana Perretta presented the case of a morbidly obese 38-year-old female patient with a BMI of 36.72kg/m2.
The procedure was performed with the patient under general anesthesia and carbon dioxide insufflation. An Overtube™ (Apollo Endosurgery, Austin, TX) was placed at the beginning of the procedure to protect the airways, the esophagus, and the hypopharynx. Each purse-string suture consisted of 6 to 8 full-thickness bites starting first on the anterior gastric wall, then on the greater curvature, and the posterior wall and moving backward in the opposite direction. Once completed, the suture was tied and knotted using a cinching device (EndoCinch™). During the live procedure, a complication occurred due to an excessive pressure placed on the EndoCinch™ handle which caused a break of the collar part of the cinch. The management of this complication was achieved by cutting the suture, so that the collar part of the cinch which grasped the mucosa could be detached with a grasper to allow for suture replacement. A total of 4 sutures were applied in order to obtain gastric tubulization.
Surgical intervention
3 months ago
526 views
7 likes
3 comments
52:53
Endoscopic sleeve gastroplasty (ESG): live educational procedure with resolution of device-related complication
Endoscopic sleeve gastroplasty (ESG) is a novel endobariatric procedure with a mechanism of action totally different from the one used for a standard sleeve gastrectomy. An over-the-scope suturing system (OverStitch™, Apollo Endosurgery, Austin, TX) mounted on a dual-channel gastroscope (GIF- 2TH180, Olympus, Center Valley, PA) allowed to place full-thickness sutures in order to obtain gastric volume reduction and shrinking. The number of applied sutures relies on the gastric volume. Sutures are placed starting from the incisura to the fundus that is spared in a U-shaped fashion. A tissue-retracting helix device is used to grab the gastric wall. In this live educational video, Professor Silvana Perretta presented the case of a morbidly obese 38-year-old female patient with a BMI of 36.72kg/m2.
The procedure was performed with the patient under general anesthesia and carbon dioxide insufflation. An Overtube™ (Apollo Endosurgery, Austin, TX) was placed at the beginning of the procedure to protect the airways, the esophagus, and the hypopharynx. Each purse-string suture consisted of 6 to 8 full-thickness bites starting first on the anterior gastric wall, then on the greater curvature, and the posterior wall and moving backward in the opposite direction. Once completed, the suture was tied and knotted using a cinching device (EndoCinch™). During the live procedure, a complication occurred due to an excessive pressure placed on the EndoCinch™ handle which caused a break of the collar part of the cinch. The management of this complication was achieved by cutting the suture, so that the collar part of the cinch which grasped the mucosa could be detached with a grasper to allow for suture replacement. A total of 4 sutures were applied in order to obtain gastric tubulization.
Endoscopic Submucosal Dissection (ESD) of the rectum for a large rectal polypoid lesion: a live educational procedure
Endoscopic Submucosal Dissection (ESD) is an endoscopic technique which allows ‘en bloc’ resection of early stage tumors and polyps in the gastrointestinal tract. In this case, Professor Yahagi presents the case of a 67-year-old male patient with an incidental finding of a large rectal polyp during an MRI study. Colonoscopy revealed a 5cm laterally spreading tumor granular type (LST-G) of the rectum, extending to one fourth of the rectal circumference. The ESD was performed with a dual channel gastroscope in retrovision due to the proximity of the LST-G to the anal verge. Glycerol and indigo carmine were injected into the submucosal plane to lift the target lesion. The mucosal incision followed by submucosal dissection was performed with a 1.5mm DualKnife™ (Olympus) using a swift coag electrosurgical setting. Hemostasis of large vessels was performed switching to the forced coag effect. The vascular submucosal network has been carefully assessed. All critical steps are evaluated during the procedure.
Surgical intervention
3 months ago
855 views
12 likes
2 comments
43:23
Endoscopic Submucosal Dissection (ESD) of the rectum for a large rectal polypoid lesion: a live educational procedure
Endoscopic Submucosal Dissection (ESD) is an endoscopic technique which allows ‘en bloc’ resection of early stage tumors and polyps in the gastrointestinal tract. In this case, Professor Yahagi presents the case of a 67-year-old male patient with an incidental finding of a large rectal polyp during an MRI study. Colonoscopy revealed a 5cm laterally spreading tumor granular type (LST-G) of the rectum, extending to one fourth of the rectal circumference. The ESD was performed with a dual channel gastroscope in retrovision due to the proximity of the LST-G to the anal verge. Glycerol and indigo carmine were injected into the submucosal plane to lift the target lesion. The mucosal incision followed by submucosal dissection was performed with a 1.5mm DualKnife™ (Olympus) using a swift coag electrosurgical setting. Hemostasis of large vessels was performed switching to the forced coag effect. The vascular submucosal network has been carefully assessed. All critical steps are evaluated during the procedure.
All you need to know to perform an ERCP for biliary stones extraction: live procedure
An 82-year-old man underwent an emergency endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis secondary to choledocholithiasis 11 days earlier. At that time, since the patient was under Clopidogrel, the sphincterotomy was not performed and a plastic stent was released in the common bile duct (CBD) to bypass the stones. In this live procedure, Dr. Boškoski performs an ERCP with sphincterotomy and biliary stones extraction. During the procedure, the operator gives every fundamental tips and tricks to perform the correct procedure. At the end of the intervention, a 3D cholangiography is performed to confirm complete biliary stones extraction.
Surgical intervention
7 months ago
837 views
15 likes
1 comment
35:21
All you need to know to perform an ERCP for biliary stones extraction: live procedure
An 82-year-old man underwent an emergency endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis secondary to choledocholithiasis 11 days earlier. At that time, since the patient was under Clopidogrel, the sphincterotomy was not performed and a plastic stent was released in the common bile duct (CBD) to bypass the stones. In this live procedure, Dr. Boškoski performs an ERCP with sphincterotomy and biliary stones extraction. During the procedure, the operator gives every fundamental tips and tricks to perform the correct procedure. At the end of the intervention, a 3D cholangiography is performed to confirm complete biliary stones extraction.
Endoscopic sleeve gastroplasty (ESG): live procedure
In this live procedure, Professor Perretta performs an endoscopic sleeve gastroplasty (ESG) using the OverStitch™ endoscopic suturing system (Apollo Endosurgery) in a 50-year-old obese male patient (with a BMI of 35.3). In this particular case, preoperative esophagogastroduodenoscopy (EGD) showed a Barrett’s esophagus with positive histology for intestinal metaplasia, which is not a contraindication for this kind of endoscopic intervention. ESG is performed with the patient under general anesthesia and carbon dioxide insufflation. The supine position is preferred because it is safer than the left lateral decubitus position as it allows for a better exposure of the stomach. Sutures are placed in a U-shaped fashion from the incisura angularis to the fundus, which is spared using the OverStitch™ suturing system, mounted on a double channel Olympus scope. The system allows for the placement of durable full-thickness stitches to obtain gastric volume reduction and shrinking.
Surgical intervention
7 months ago
674 views
10 likes
1 comment
38:23
Endoscopic sleeve gastroplasty (ESG): live procedure
In this live procedure, Professor Perretta performs an endoscopic sleeve gastroplasty (ESG) using the OverStitch™ endoscopic suturing system (Apollo Endosurgery) in a 50-year-old obese male patient (with a BMI of 35.3). In this particular case, preoperative esophagogastroduodenoscopy (EGD) showed a Barrett’s esophagus with positive histology for intestinal metaplasia, which is not a contraindication for this kind of endoscopic intervention. ESG is performed with the patient under general anesthesia and carbon dioxide insufflation. The supine position is preferred because it is safer than the left lateral decubitus position as it allows for a better exposure of the stomach. Sutures are placed in a U-shaped fashion from the incisura angularis to the fundus, which is spared using the OverStitch™ suturing system, mounted on a double channel Olympus scope. The system allows for the placement of durable full-thickness stitches to obtain gastric volume reduction and shrinking.
Peroral endoscopic myotomy of a suspected type III achalasia with a double scope control
A 59-year-old woman was referred to our unit for progressive dysphagia and chest pain associated with heartburn and chest fullness. A nutcracker esophagus was suspected at the HD manometry and the patient was scheduled for a peroral endoscopic myotomy (POEM). The procedure started with an esophagogastroduodenal series (EGDS), which showed abnormal contractions of the distal esophagus and increased resistance at the level of the esophagogastric junction (EGJ) with a high suspicion of type III achalasia. The tunnel was started 12cm above the EGJ in a 5 o’clock position. After submucosal injection, a mucosal incision was made with a new triangle-tip (TT) knife equipped with water jet facility. The access to the submucosa was gained and a submucosal longitudinal tunnel was created until the EGJ, dissecting the submucosal fibers with the TT knife. The myotomy was performed by completely dissecting the circular muscular layer muscle fibers using swift coagulation. To assess the extension of the myotomy just at the level of the EGJ, a “double scope control” was performed by inserting a pediatric scope, which confirmed the presence of the mother scope light in the esophagus. The submucosal tunnel and the myotomy were then extended together for 1 to 2cm. A second check with the pediatric scope showed the presence of the mother scope light in the correct position above the EGJ. The mucosal incision site was finally closed using multiple endoclips.
Surgical intervention
1 year ago
486 views
6 likes
0 comments
25:51
Peroral endoscopic myotomy of a suspected type III achalasia with a double scope control
A 59-year-old woman was referred to our unit for progressive dysphagia and chest pain associated with heartburn and chest fullness. A nutcracker esophagus was suspected at the HD manometry and the patient was scheduled for a peroral endoscopic myotomy (POEM). The procedure started with an esophagogastroduodenal series (EGDS), which showed abnormal contractions of the distal esophagus and increased resistance at the level of the esophagogastric junction (EGJ) with a high suspicion of type III achalasia. The tunnel was started 12cm above the EGJ in a 5 o’clock position. After submucosal injection, a mucosal incision was made with a new triangle-tip (TT) knife equipped with water jet facility. The access to the submucosa was gained and a submucosal longitudinal tunnel was created until the EGJ, dissecting the submucosal fibers with the TT knife. The myotomy was performed by completely dissecting the circular muscular layer muscle fibers using swift coagulation. To assess the extension of the myotomy just at the level of the EGJ, a “double scope control” was performed by inserting a pediatric scope, which confirmed the presence of the mother scope light in the esophagus. The submucosal tunnel and the myotomy were then extended together for 1 to 2cm. A second check with the pediatric scope showed the presence of the mother scope light in the correct position above the EGJ. The mucosal incision site was finally closed using multiple endoclips.
Endoscopic sleeve gastroplasty: live procedure
Endoscopic sleeve gastroplasty is a novel endobariatric procedure with a mechanism of action totally different from the one used for a standard sleeve gastrectomy. An over-the-scope suturing system mounted on a dual-channel Olympus® scope allowed to place full-thickness sutures in order to reduce the volume and the size of the stomach. The procedure was performed with the patient under general anesthesia and carbon dioxide insufflation. Once the Overtube™ was placed, the scope equipped with the OverStitch™ (Apollo Endosurgery®, Austin, Tex) suturing device was inserted through the stomach, and the suturing was initiated at the level of the incisura. The tissue-retracting helix device was used to grab the stomach wall, allowing for full-thickness bites. Each suture consisted of multiple sequential U-shaped bites along the anterior wall, the greater curvature, the posterior wall, and then in the opposite direction. Once completed, the suture was tied and knotted using a cinching device. Three sutures were applied in order to obtain gastric tubulization, and to spare the fundus.
Surgical intervention
1 year ago
1163 views
6 likes
0 comments
18:32
Endoscopic sleeve gastroplasty: live procedure
Endoscopic sleeve gastroplasty is a novel endobariatric procedure with a mechanism of action totally different from the one used for a standard sleeve gastrectomy. An over-the-scope suturing system mounted on a dual-channel Olympus® scope allowed to place full-thickness sutures in order to reduce the volume and the size of the stomach. The procedure was performed with the patient under general anesthesia and carbon dioxide insufflation. Once the Overtube™ was placed, the scope equipped with the OverStitch™ (Apollo Endosurgery®, Austin, Tex) suturing device was inserted through the stomach, and the suturing was initiated at the level of the incisura. The tissue-retracting helix device was used to grab the stomach wall, allowing for full-thickness bites. Each suture consisted of multiple sequential U-shaped bites along the anterior wall, the greater curvature, the posterior wall, and then in the opposite direction. Once completed, the suture was tied and knotted using a cinching device. Three sutures were applied in order to obtain gastric tubulization, and to spare the fundus.
Endoscopic mucosal resection (EMR) of multiple hyperplastic polyps of the stomach
A 69 year-old man with a history of hypertension, type 2 diabetes, and renal insufficiency underwent a gastroscopy for chronic anemia. During this procedure, a 3cm hyperplastic gastric polyp was discovered. The patient was scheduled for endoscopic submucosal dissection (ESD). The procedure started with a gastroscopy, which showed a normal duodenum and many gastric hyperplastic polyps. The largest one was a pedunculated polyp of about 3cm in size at the level of the greater curvature. The operator opted for endoscopic mucosal resection (EMR) of the multiple polyps. After submucosal injection, polyps were resected using a snare (ENDO CUT® Q mode). All resected polyps were retrieved with a Roth Net® for histological evaluation.
Surgical intervention
1 year ago
403 views
1 like
0 comments
08:46
Endoscopic mucosal resection (EMR) of multiple hyperplastic polyps of the stomach
A 69 year-old man with a history of hypertension, type 2 diabetes, and renal insufficiency underwent a gastroscopy for chronic anemia. During this procedure, a 3cm hyperplastic gastric polyp was discovered. The patient was scheduled for endoscopic submucosal dissection (ESD). The procedure started with a gastroscopy, which showed a normal duodenum and many gastric hyperplastic polyps. The largest one was a pedunculated polyp of about 3cm in size at the level of the greater curvature. The operator opted for endoscopic mucosal resection (EMR) of the multiple polyps. After submucosal injection, polyps were resected using a snare (ENDO CUT® Q mode). All resected polyps were retrieved with a Roth Net® for histological evaluation.
Laparoscopic management of perforated ulcer of the stomach
A 43-year-old woman with a history of chronic use of NSAIDs was admitted to the emergency care unit for acute abdominal epigastric pain. CT-scan showed both free air and fluid in the peritoneal cavity with marked thickening and irregularity at the level of the gastric antrum and the duodenal bulb. The patient underwent emergency laparoscopy. A large amount of purulent fluid was found in the peritoneal cavity and evacuated. The gastric defect was identified at the level of the anterior wall of the gastric antrum. A 2/0 Vicryl suture is used to oversew the perforation. As an additional protection, an omental patch was brought in place and fixed against the sutured lesion. Abundant peritoneal lavage was performed. The patient was discharged on postoperative day 5. One month later, esophagogastroduodenoscopies (EGDs) with biopsies of the ulcer’s margins were performed.
Surgical intervention
1 year ago
6625 views
31 likes
3 comments
06:55
Laparoscopic management of perforated ulcer of the stomach
A 43-year-old woman with a history of chronic use of NSAIDs was admitted to the emergency care unit for acute abdominal epigastric pain. CT-scan showed both free air and fluid in the peritoneal cavity with marked thickening and irregularity at the level of the gastric antrum and the duodenal bulb. The patient underwent emergency laparoscopy. A large amount of purulent fluid was found in the peritoneal cavity and evacuated. The gastric defect was identified at the level of the anterior wall of the gastric antrum. A 2/0 Vicryl suture is used to oversew the perforation. As an additional protection, an omental patch was brought in place and fixed against the sutured lesion. Abundant peritoneal lavage was performed. The patient was discharged on postoperative day 5. One month later, esophagogastroduodenoscopies (EGDs) with biopsies of the ulcer’s margins were performed.
Endoscopic internal drainage of gastric fistula after sleeve gastrectomy
Gastric fistula is a major adverse event after sleeve gastrectomy.
In this live instructional video, authors present the case of a 45-year-old woman with a complex postoperative course after sleeve gastrectomy due to a gastric leakage and a twisted stomach. The patient had already been managed with the endoscopic placement of a fully covered metal stent and a percutaneous drainage with no resolution of the fistula.
The first step of the procedure consists in the removal of a 16cm fully covered stent using a grasper. After contrast injection, the leakage and the gastric twist are visualized. Under fluoroscopic control, a 30mm pneumatic dilatation of the twist is obtained. Two double pigtail plastic stents are placed between the stomach and the abscess cavity in order to achieve internal drainage and facilitate the healing process. The percutaneous drainage will be removed one day after the procedure while the plastic stents will be removed after 3 months.
Surgical intervention
1 year ago
974 views
6 likes
0 comments
14:45
Endoscopic internal drainage of gastric fistula after sleeve gastrectomy
Gastric fistula is a major adverse event after sleeve gastrectomy.
In this live instructional video, authors present the case of a 45-year-old woman with a complex postoperative course after sleeve gastrectomy due to a gastric leakage and a twisted stomach. The patient had already been managed with the endoscopic placement of a fully covered metal stent and a percutaneous drainage with no resolution of the fistula.
The first step of the procedure consists in the removal of a 16cm fully covered stent using a grasper. After contrast injection, the leakage and the gastric twist are visualized. Under fluoroscopic control, a 30mm pneumatic dilatation of the twist is obtained. Two double pigtail plastic stents are placed between the stomach and the abscess cavity in order to achieve internal drainage and facilitate the healing process. The percutaneous drainage will be removed one day after the procedure while the plastic stents will be removed after 3 months.
EUS gastrojejunal anastomosis with HOT AXIOS® stent after Whipple pancreatectomy, filling blind loop through percutaneous transhepatic biliary drainage
A 67-year-old woman underwent a Whipple pancreatectomy for cancer one year earlier. She was readmitted to hospital for abdominal pain and subocclusion with jaundice. CT-scan showed a dilatation of the jejunal stump with associated biliary tree dilatation. Percutaneous biliary transhepatic drainage (PBTHD) was performed and a stenosis was diagnosed in the afferent loop, accountable for subocclusion and secondary jaundice. Two double pigtails were delivered by the interventional radiologist through PBTHD across the jejunal stricture without resolution of symptoms. Biliary drainage was left in place causing patient discomfort. EUS gastrojejunal anastomosis (GJA) using the HOT AXIOS® stent was attempted in order to bypass the stricture. EUS allows to find the jejunal stump, detected by mechanical staple line visualization. Additionally, the blind loop was detected as it was filled up with liquid and contrast through the PBTHD. The HOT AXIOS® stent was delivered without any complications (VIDEO). Afterwards, flow of bile and liquid was observed through the lumen-apposing metal stent (LAMS). PBTHD was immediately removed. Recovery was uneventful and the patient was discharged on a normal diet with no pain on the following day. EUS-GJA via a LAMS is a well-described technique in experts’ hands (Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Itoi T, Baron TH, Khashab MA, et al. Dig Endosc 2017;29:495-502). Special skills and techniques are necessary in order to recognize the exact small bowel loop to puncture (Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Tyberg A, Perez-Miranda M, Sanchez-Ocaña R et al. Endosc Int Open 2016;4:E276-81). In that case, we show that filling this loop using a previous transhepatic access should be considered an alternative in case of alterated anatomy. Also direct EUS transgastric injection of contrast medium in the dilated biliary tree to fill up the jejunal stump could be considered an option to perform GJA by a single operator in a single session after safely recognizing the right loop. In addition, fluoroscopy helps to detect the exact loop puncture site. In conclusion, GJA using a LAMS is feasible, safe and useful, and transhepatic injection of liquid and contrast medium helps to adequately recognize the jejunal stump after biliopancreatic surgery.
Surgical intervention
1 year ago
238 views
3 likes
0 comments
02:30
EUS gastrojejunal anastomosis with HOT AXIOS® stent after Whipple pancreatectomy, filling blind loop through percutaneous transhepatic biliary drainage
A 67-year-old woman underwent a Whipple pancreatectomy for cancer one year earlier. She was readmitted to hospital for abdominal pain and subocclusion with jaundice. CT-scan showed a dilatation of the jejunal stump with associated biliary tree dilatation. Percutaneous biliary transhepatic drainage (PBTHD) was performed and a stenosis was diagnosed in the afferent loop, accountable for subocclusion and secondary jaundice. Two double pigtails were delivered by the interventional radiologist through PBTHD across the jejunal stricture without resolution of symptoms. Biliary drainage was left in place causing patient discomfort. EUS gastrojejunal anastomosis (GJA) using the HOT AXIOS® stent was attempted in order to bypass the stricture. EUS allows to find the jejunal stump, detected by mechanical staple line visualization. Additionally, the blind loop was detected as it was filled up with liquid and contrast through the PBTHD. The HOT AXIOS® stent was delivered without any complications (VIDEO). Afterwards, flow of bile and liquid was observed through the lumen-apposing metal stent (LAMS). PBTHD was immediately removed. Recovery was uneventful and the patient was discharged on a normal diet with no pain on the following day. EUS-GJA via a LAMS is a well-described technique in experts’ hands (Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Itoi T, Baron TH, Khashab MA, et al. Dig Endosc 2017;29:495-502). Special skills and techniques are necessary in order to recognize the exact small bowel loop to puncture (Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Tyberg A, Perez-Miranda M, Sanchez-Ocaña R et al. Endosc Int Open 2016;4:E276-81). In that case, we show that filling this loop using a previous transhepatic access should be considered an alternative in case of alterated anatomy. Also direct EUS transgastric injection of contrast medium in the dilated biliary tree to fill up the jejunal stump could be considered an option to perform GJA by a single operator in a single session after safely recognizing the right loop. In addition, fluoroscopy helps to detect the exact loop puncture site. In conclusion, GJA using a LAMS is feasible, safe and useful, and transhepatic injection of liquid and contrast medium helps to adequately recognize the jejunal stump after biliopancreatic surgery.